Advanced prenatal MRI assessment of placental function, foetal heart development and early cardiovascular health

Neonatal coarcation of the aorta (CoA) accounts for 7% of congenital heart disease (CHD), but with false positive rates from fetal ultrasound of up to 50-90%.

There is however significant crossover between the cardiac phenotype observed in suspected CoA and that described in uteroplacental insufficiency (UPI), which may also be difficult to detect.

Both conditions have been independently linked with structural placental abnormalities, fetal growth restriction, abnormal vascular function, and an increased risk of cardiovascular events in later life.

This project aims to understand the relationship between placental function, development of the left heart and early cardiovascular health, using a unique combination of novel 3D/4D fetal MRI methods to generate a comprehensive, non-invasive profile of the fetoplacental circulation in a spectrum of left-sided CHD (CoA and hypoplastic left heart syndrome).

Casual inference methods will be used characterise the baseline fetoplacental conditions associated with underdevelopment of the left heart, including the fetoplacental response to maternal hyperoxygenation.

Machine learning methods will then be used to accurately model the severe neonatal CoA phenotype and improve prenatal risk stratification.

Finally, postnatal follow-up at one-year of age will provide longitudinal insights into the relationship between intrauterine environment and early markers of cardiovascular health.